Academic and professional career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt

Abstract

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed. Fifty medical school graduates (2.5 %) initially failed Step 1. Compared to graduates who initially passed Step 1, a higher proportion of graduates who initially failed Step 1 became primary care physicians (26/49 [53 %] vs. 766/1,870 [40.9 %]), were more likely at graduation to report intent to practice in underserved areas (28/50 [56 %] vs. 419/1,939 [ 21.6 %]), and more likely to take 5 or more years to graduate (11/50 [22.0 %] vs. 79/1,953 [4.0 %]). The relative risk of first attempt Step 1 failure for medical school graduates was 13.4 for African Americans, 7.4 for Latinos, 3.6 for matriculants >22 years of age, 3.2 for women, and 2.3 for first generation college graduates. The relative risk of not being specialty board certified for those graduates who initially failed Step 1 was 2.2. Our observations regarding characteristics of graduates in our study cohort who initially failed Step 1 can inform efforts by medical schools to identify and assist students who are at particular risk of failing Step 1.

Impact of performance in a mandatory postgraduate surgical examination on selection into specialty training

“…In keeping with other studies22, 23, 24, 25, these results suggest that candidates who require multiple attempts at a postgraduate medical examination are more likely to struggle with other medical assessment processes (in this case, assessment via a selection process). This information may identify doctors who will require additional support through their training and guide national bodies when considering borderline candidates or appeals.…”

“…For example, McDougle and colleagues23 compared graduates who initially failed Step 1 of the USMLE ® with those who passed it first time, finding that the relative risk of not being specialty board certified was 2·2. Multiple attempts at the Medical College Admission Test (MCAT) have also been associated with an increased risk of failing Step 2 of the USMLE ®24 , whereas multiple attempts at the Professional and Linguistic Assessments Board (PLAB) test have been shown to be independently predictive of unsatisfactory training performance25.…”

A holistic review of the medical school admission process: examining correlates of academic underperformance

“…Selection practices may include such factors as screening processes, consideration given to students applying through special programs (e.g., early decision, combined degree programs), or the point in the admission cycle that an applicant receives notification of acceptance (e.g., during the regular admission period, later from the alternate list, etc.). Finally, both short-term (e.g., routine promotion during medical school, completion of USMLE Step Examinations, or appearances before professional code or student progress committees) and long-term outcomes (e.g., specialty selection, practice location, or state medical board disciplinary action) have the potential to inform aspects of each school's medical admission process (9). …”

Identifying and Supporting Students at Risk of Failing the National Medical Licensure Examination in Japan Using a Predictive Pass Rate

“…In many countries such as the US, Germany, and Japan, medical students need to pass the National Medical Licensure Examination (NMLE) in order to take a physician's license, and students who fail to pass the NMLE pose a huge problem from the educational standpoint of healthcare professionals. [1][2][3][4][5][6] Students failing USMLE Step 1 are often delayed from continuing course work, which affects their graduation and increases costs. 4 Failing Step 1 can also affect a student's ability to enter a residency program and in some instances restrict them from applying for residency in speci c states.…”

“…Most studies in the past decade have primarily focused on the outcome 3,5 or poor performance 2,6 of those who fail USMLE or NMLE. To the best of our knowledge, there are only two studies in the US and Netherlands that have attempted to create models for predicting those who will fail among rst-time test takers of Step 1 4 , and in the rst-year undergraduate medical curriculum 1 .…”